睾丸精原细胞瘤78例临床分析

目的：对78例精原细胞瘤患者的治疗结果及其预后因素加以分析。方法：1983年7月至1992年4月收治78例睾丸精原细胞瘤，均经病理证实为纯精原细胞瘤。78例中74例手术治疗，63例术后放疗，43例联合化疗。结果：中位随访6.6年（随访期5-10年），根据《现代肿瘤学》的分期标准。Ⅰ期44例。Ⅱ期21例。Ⅲ期3例。Ⅳ期10例。全组5，10年生存率分别为；Ⅰ期93.2%,87.0%,Ⅱ期66.7%,60.0%,Ⅲ期33.3%,33.3%,Ⅳ期0，0。结论：临床分期，放疗剂量及联合化疗是影响预后的重要因素。强调高位精索加睾丸切除术及术后预防放疗DT2500cDy为Ⅰ期患者首选治疗方案，Ⅱ期以上患者应术后放疗加联合化疗。     

睾丸精原细胞瘤的临床治疗

1975年3月至1987年12月我院收治了经病理证实的睾丸精原细胞瘤病例109例，Ⅰ期73例，Ⅱ期28例，Ⅲ期5例，Ⅳ期3例。治疗方法均为术后加放疗，中晚期的13例会并N-甲酰溶肉瘤素化疗，预后与分期有关。3、5、8年生存率为82．6％、771％、66．7％。主要死因为血道转移．1987年以后对ⅡB期、Ⅲ期于放疗前后采用了以顺铂为主的有计划的联合化疗。结果提示：对于Ⅰ、ⅡA。期患者，单纯隔下放疗即可，ⅡB。、Ⅲ期应放疗合并卡铂为主的联合化疗。     

间接淋巴结造影对盆腔淋巴结清扫术的意义

目的　探讨间接淋巴结造影对盆腔淋巴结清扫术的临床意义。方法　采用直肠黏膜下间接淋巴结造影 ,对 3 2例妇科恶性肿瘤患者 ,术前行淋巴结造影并摄X线片 ,术后行病理组织学检查。结果　造影检查阳性 10例患者中 8例与病理检查结果相符 ,阳性符合率为 80 % ( 8/10 ) ;而造影结果阴性患者病理检查结果均为阴性 ,阴性符合率为 10 0 % ( 2 2 /2 2 )。结论　间接淋巴结造影有助于正确判断淋巴结是否彻底清扫 ,从而使盆腔淋巴结清扫术更具主动性 ,提高了淋巴结清扫的彻底性     

睾丸精原细胞瘤的疗效及预后因素分析

作者分析了５０例睾丸精原细胞瘤的疗效及预后因素。术后单纯放疗２４例，放疗加化疗１３例，两组的５年、１０年生存率分别为９１．７％及８４．３％，Ｐ＞０．０５，单纯化疗１３例，５年生存率为９０．９％，与放疗、化疗组相比，Ｐ＞０．０５。年龄＜４０岁和≥４０岁的病例的５年、１０年生存率分别为９５．７％和６８．８％，Ｐ＜０．０５。结果表明，Ⅰ期睾丸精原细胞瘤病例手术后宜行单纯放疗，若复发，可行放疗加化疗；年龄较轻的病例生存率较高；β－绒毛膜促性腺激素水平、隐睾及隐睾部位与生存率关系不大。     

Testicular tumors: Oncologic imaging and diagnosis

The extreme radiosensitivity of testicular seminomas plus recent advances in chemotherapy for nonseminomatous tumors and for advanced seminomas have made long term survival possible in the large majority of patients with testis cancer. Since choice of therapy is determined by tumor histology and extent of disease, accurate clinical staging is critical. Computed tomography (CT) of the abdomen and chest is the imaging procedure of choice for staging testis cancer. Clinical staging accuracy of 80 to 90% can be achieved using CT in combination with radioimmunoassays for β-HCG and AFP. Ultrasonography (US), while less sensitive and specific than CT for determining nodal status, may be useful in thin patients with sparse retroperitoneal fat; in addition US may play an important role in detecting occult testicular neoplasms and in assessing primary tumor extent within the scrotum. Lymphangiography should be reserved for Stage I patients in whom elective treatment of the retroperitoneum is not planned. Follow-up should include serial radioimmunoassays for serum AFP and β-HCG and periodic CT examinations of the abdomen and chest. Technical improvements in CT scanners and further experience with the use of tumor markers should help refine our ability to stage and manage patients with testicular tumors. In addition, nuclear magnetic resonance (NMR) imaging and radionuclide imaging following injection of radioactively labelled antibodies to AFP and β-HCG are new techniques which offer great promise for the future.     

Seminoma of the testis: a 22-year experience with radiation therapy

An analysis is presented of 188 patients with a histological diagnosis of seminoma testis, treated by radical orchiectomy and radiation therapy between 1960 and 1981 at the Cross Cancer Institute. Using the Walter Reed Hospital staging classification, 149 (79%) patients were Stage I, 34 (18%) were Stage II, and 5 (3%) were Stage III. The 5-year survival for all stages was 90%, and for Stage I was 98%, Stage II, 71%, and Stage III, 0%. All were treated primarily with radiation therapy. Prophylactic mediastinal radiation was not employed for Stage I, and was employed in half of Stage II patients. Eleven patients with Stage I relapsed, five in the mediastinum and/or neck nodes. Eight of 11 were cured with further treatment. Stage II patients were subdivided according to the presence or absence of a palpable abdominal mass. Palpable disease (Stage IIB) carried a poorer prognosis. Three of 20 patients without a palpable mass (Stage IIA) died of disease; there was an 82% five-year survival rate. Eight of 14 with a palpable mass (Stage IIB) were cured by radiotherapy; there was a 54% five-year survival rate. All five Stage III patients died within 1 year of diagnosis. Stage I and IIA seminoma is curable by radiation alone. Prophylactic mediastinal radiation is not indicated in either Stage I or IIA disease. Long term toxicity from radiation is not seen. Optimal treatment for Stage IIB disease is undetermined and new treatment regimens should be explored. Stage III disease requires primary chemotherapy.     

Testicular Cancer Biomarkers: A Role for Precision Medicine in Testicular Cancer

Testicular germ cell tumors (TGCTs) represent the most common solid tumors among men aged 15 to 34 years. Fortunately, recent advances have made testicular cancer a highly curable disease. Despite the high cure rates, there are still several areas in testis cancer care where treatment decisions are controversial and guided only with clinical factors and historic serum tumor markers. Unfortunately, unlike other genitourinary malignancies, modern research techniques have not been widely tested or applied to germ cell tumors, perhaps as a result of excellent prognosis in this cohort of young men. Despite this, there remain numerous challenges and pitfalls in testis cancer care that need to be addressed.A reliable set of biomarkers could be extremely useful in helping risk-stratify patients, detect relapse early, guide surgical decision-making, and tailor follow-up.Current tumor markers (Alpha-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase) have low accuracy and low sensitivity when used not only as diagnostic but also as prognostic and predictive markers. In twenty-first century medicine, there is a role for further prognostic stratification and the development of novel biomarkers that offer greater sensitivity and specificity for TGCTs. Despite the initial promising results, the majority of preclinical biomarkers do not, as yet have a proven validated role in clinical practice, and future prospective trials are needed to support and confirm the results of cohort studies.In this narrative review, we aimed to highlight the recent innovations in the development and implementation of novel testicular tumor markers and discuss their clinical applications and limitations in the management of this disease.     

睾丸精原细胞瘤免疫表型及临床病理分析

目的探讨睾丸精原细胞瘤的免疫表型、临床病理特征、诊断和鉴别诊断。方法通过光镜观察和多种免疫组化标记，分析8例睾丸精原细胞瘤病理组织学特征和免疫组化在诊断和鉴别诊断中的意义。结果8例睾丸精原细胞瘤，平均年龄41．4岁，巨检肿瘤均呈类长椭圆形，最大径平均10．4cm，包膜完整，切面灰白色鱼肉状；镜下均表现为典型精原细胞瘤的病理组织学特征；免疫组化PLAP、D2-40、CD117均为强阳性（8／8），其中2例HCG—α阳性，1例CD30阳性：而AFP、CK—LMW及Vim均为阴性（8／8）。结论睾丸精原细胞瘤好发于中年男性，其诊断主要依据典型的病理组织学特征和免疫组化检测，免疫标记物PLAP、D2-40、CD117、CD30、HCG和AFP在诊断和鉴别诊断中具有重要作用。     

Role of radiotherapy in organ-sparing treatment of seminoma

Radical orchiectomy is the standard treatment for patients with seminoma. In both bilateral and unilateral testicular cancer, this therapy results in infertility, permanent androgen replacement treatment and significant psychological problems stemming from castration. Given that most patients with germinal cell tumours are long-term survivors, quality of life is becoming more and more relevant in therapeutic decision-making. We present a case of metachronous bilateral seminoma treated with tumour enucleation and adjuvant local radiotherapy. We also provide a review of the literature on the role of radiotherapy in organ sparing.     

腹股沟隐睾精原细胞瘤和阴囊睾丸精原细胞瘤预后的比较

目的分析腹股沟隐睾精原细胞瘤的预后,提出治疗方法。方法我们回顾性分析了１９５８～１９９１年治疗的４３例患者。根据我院精原细胞瘤分期标准,Ⅰ期３３例,Ⅱ期８例,Ⅲ、Ⅳ期各１例。所有患者均经腹股沟隐睾肿瘤切除术,Ⅰ、Ⅱ期以放射治疗为主,Ⅲ及Ⅳ期各１例分别行放疗或化疗。结果全组总的５年、１０年生存率分别为９３．０％和９０．３％,相应无病生存率分别为８８．１％和８５．３％。Ⅰ期５年、１０年总生存率均为１００％,Ⅱ期为７５．０％和６０．０％。２例复发,经放疗治愈。结论本组研究结果表明,腹股沟隐睾精原细胞瘤预后较好,和阴囊睾丸精原细胞瘤相似。建议对Ⅰ期、Ⅱ期早行术后腹主动脉旁和同侧盆腔淋巴结照射。当有腹股沟淋巴结转移或原发肿瘤明显侵及腹股沟周围组织时,再行腹股沟照射。     

Seminoma of the testis: Results of treatment and patterns of failure after radiation therapy

Four hundred and forty-four patients with the histological diagnosis of pure seminoma were treated at The Princess Margaret Hospital between 1958 and 1976. Using the Walter Reed Hospital staging classification, 338 patients (76.1 %) were Stage I, 86 (19.4 %) were Stage II, and 20 (4.7%) were Stage III. The 5 year actuarial survival rate (5 yr S_A) for all stages was 87%, and for Stages I, II and III: 94%, 74% and 32% respectively. In Stage II the 5-year S_A was significantly worse when palpable abdominal disease was present (62%, vs 87% when it was absent, p < .02). Prophylactic mediastinal irradiation was not used for patients with Stage II disease. None of 40 Stage II patients without palpable abdominal disease recurred in the non-irradiated mediastinum. Ten of 46 Stage It patients with palpable abdominal disease recurred in the mediastinum; 7 of the 10 were cured with mediastinal irradiation at the time of relapse. Prophylactic mediastinal irradiation appears unnecessary in Stage II patients. The Stage III category includes a subgroup of patients who were curable with radiation therapy: $\text{5}\text{6}$ with supradiaphragmatic nodal disease without palpable abdominal or visceral disease were cured. Exploration of new treatment methods appears indicated for the salvage of patients recurring in sites other than the mediastinum or supraclavicular fossa and for patients presenting with visceral disease.     

Testicular Cancer and Testicular Self-Examination; Knowledge,Attitudes and Practice in Final Year Medical Students in Nigeria

The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint® lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question "How important to men’s health is regular testicular self-examination?" Answers to the questions "Do you think it is worthwhile to examine your testis regularly?" and "Would you be interested in more information on testicular cancer and testicular self-examination?" were also suboptimal, but improved post intervention p<0.001, pof TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.     

Combination Chemotherapy with Vinblastine, Ifosfamide and Cisplatin in Bulky Seminoma

Since 1982, 24 patients with bulky seminoma were treated with the VIP-regimen consisting of vinblastine 6 mg/m² days 1+2, ifosfamide 1.5 g/m² days 1-5, cisplatin 20 mg/m² days 1-5. One patient showed primary progression, another patient partial remission, and one patient died during the first cycle. All the other patients had complete remission (21/24=87%), which was documented histologically in 9 patients. One patient relapsed but obtained complete remission after repeated treatment. Thus 21 patients are currently living without disease after a median observation time of 30+ months. Bone marrow toxicity was severe, leading to dose reduction in more than 50% of the patients. No other severe side effects were observed. We conclude that the regimen is highly effective in bulky seminoma. Reduction of the vinblastine dose is recommended because of bone marrow toxicity.     

Prognostic Role of Early Interim Fluorodeoxyglucose Positron Emission Tomography in Patients With Advanced Seminoma Undergoing Standard Treatment

BackgroundPatients with advanced seminoma have an exceedingly favorable prognosis. Studies aiming to reduce the total treatment burden and side effects in patients with well-defined disease and very good prognosis are warranted.Patients and MethodsIn a prospective observational study, patients with advanced stage seminoma were treated with bleomycin, etoposide, and cisplatin (BEP) or EP according to guidelines. Fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET/CT) examinations were performed at baseline, after 2 cycles (PET/CT2) in all patients, and after chemotherapy at the physician’s discretion. Disease response to treatment assessed by PET/CT was qualitatively evaluated by 2 independent nuclear medicine physicians. Contrast-enhanced CT scans were also performed according to guidelines (at baseline, after treatment, during follow-up). The study’s primary endpoint was to evaluate the association between PET/CT2 findings and relapse-free survival.ResultsFrom January 2009 to January 2017, a total of 75 consecutive patients were enrolled, of whom 70 were included for analysis. The clinical disease stage was IIA-B and IIC-III in 40% and 60%, respectively. By local assessment, 46 PET/CT2 scans (65.7%) were reported as negative, and 46% of these patients had stage IIC-III disease. Five-year relapse-free survival of PET/CT2-positive patients was 75% (95% confidence interval, 60-95) compared to 97.8% (95% confidence interval, 93.7-100) of PET/CT2-negative patients (P = .002). In univariate analyses, PET/CT2 was significantly associated with relapse-free survival (P = .02).ConclusionsNo residual FDG uptake after 2 cycles of conventional chemotherapy is prognostic in advanced seminoma, but it may be useful to optimize the standard prognostic risk groups and may be tested within larger prospective clinical trials of chemotherapy deescalation.     

Successful Surgical Treatment of Malignant Hypertension due to Metastatic Seminoma

We report the case of a 39 year old man with recent onset of malignant hypertension due to renal artery compression by seminoma. The only testicular abnormality was a small area of scar tissue, which may have represented spontaneous primary tumour regression. Tumour excision and nephrectomy returned the patient's blood pressure to normal limits.     

Radiation therapy of seminoma of the testis

Seventy-three consecutive patients with seminom of the testis were treated by orcbiectomy followed by radiation alone. Sixty-six patients (9196) survived for more than five years. Forty-nine of fifty-six (87 %) survived for more than tan years. The five-year survival for 54 patients with Stage I disease was 100 % ; it was 92 % for 13 patients with Stage II disease. None of the six Stage III patients smviv All those who survived for five years were leading an active and normal life as of this writing. The Karoofsky's performance status was 90–100 for 50 patients who were followed is detail. Routine postoperative irradiation of the pare-aortic lymphatics was sufficient to produce a permanent cure without resorting to chemotherapy or prophylactic irradiation of mediastinum and supraclavicular regions. The optimal tissue does was 3000 rad. It may be increased to 3500–4000 rod by reducing the portal, but the total dose should be kept under 4000 rad. Pulmonary metastases were treated by bilateral whole hog irradiation of 1000–1500 rad followed by a coal boost dose of 2000–2500 rad. The treatment was well-tolerated by the patient. Large intra-abdominal metastases involving the internal organs should be treated by means other than radiation alone.     

Testicular Seminoma in Denmark 1976-1980 Results of Treatment

Over a five-year period the DATECA Study included 554 consecutive patients with seminoma, representing practically all cases in the country. The stage distribution was: stage I 424 patients, stage II 110 patients, and stage III 17 patients. Typical seminoma was registered in 515 patients, anaplastic seminoma in 26 patients, and spermatocytic seminoma in 13 patients. The treatment was postoperative irradiation except in a few very advanced cases who received chemotherapy. Three-year corrected survival was: stage I 99 per cent, stage II 89 per cent, and stage III 65 per cent. Anaplastic seminoma showed a singnificantly higher rate of metastatic spread than typical seminoma and the prognosis was worse. Treatment-related complications were few, but adjuvant bleomycin combined with irradiation of advanced seminoma resulted in 2 deaths from pneumonitis.     

Testicular seminoma: analysis of treatment and failure for stage II disease

Seventy-three patients with seminoma testis stage II have been retrospectively analyzed with regard to prognostic factors and value of prophylactic mediastinal irradiation and chemotherapy. Although survival differences were seen between stage IIa, IIb and IIc, these were not statistically significant. Neither was there a significant difference between IIc patients with tumors greater than 10 cm and less than 10 cm in diameter. The incidence of HCG-producing seminomas in the present series was 16%. No significant difference in survival nor relapse rate was found between HCG-producing and HCG-non-producing seminomas. Prophylactic mediastinal irradiation did not influence the survival nor the relapse rate and may therefore be omitted. In the present series there was no significant improvement neither in relapse rate nor survival in patients receiving pre-irradiation chemotherapy. However, the total number of patients is small and optimal pre-irradiation chemotherapy still have to be defined.